OP0196 HIGH SYMPTOM BURDEN AND LIMITED CHANGES IN FIBROMYALGIA PATIENTS’ HEALTH STATUS TWO YEARS AFTER PARTICIPATION IN A MULTICOMPONENT REHABILITATION PROGRAMME
Authors: H. A. Zangi, T. Haugmark, S. A. Provan, K. B. Hagen
Journal: Annals of the Rheumatic Diseases (2022)

Background Patients with fibromyalgia (FM) suffer from high symptom burden and few available treatments. EULAR evidence-based recommendations for the management of FM state that optimal management should focus on prompt diagnosis, patient education and non-pharmacological treatments 1 . A recent systematic review of mindfulness- and acceptance-based interventions for patients with FM showed small to moderate beneficial health effects 2 . We tested a 10-session group-based mindfulness- and acceptance-based intervention, the Vitality Training Programme 3 , followed by low threshold physical exercise counselling in primary health care, compared to treatment as usual (TAU) for patients diagnosed with FM. Objectives To explore possible changes in health status in a group of FM patients two years after participation in a multicomponent rehabilitation programme. Methods A total of 170 patients with confirmed FM diagnosis according to ACR 2011-criteria were randomised, 85 to intervention and 85 to control. Self-reported data were collected electronically at baseline, 3 and 12 months. There were no statistically significant health effects in any disease-related variables at 12 months. However, there were significant between-group differences in patients’ tendency to be mindful 4 . All patients were asked to complete the same questionnaires two years after completion of the intervention group. Because the TAU-group had been offered the same programme after 12 months, only data from the intervention group was included in this study. Primary outcome was Patient Global Impression of Change (PGIC), scored as 1= much worse, through 4=no change, to 7=much better. Values 6 and 7 were considered clinically relevant improvement. Secondary outcomes were self-reported pain, fatigue, sleep quality, psychological distress, mindfulness, physical activity, motivation and barriers for physical activity, and work participation. Mean changes from baseline to two years were analysed by paired sample t-tests. Results Totally, 48 (56.5%) of the patients who had been randomised to the intervention group responded to the questionnaires, 94% female, median (range) age 47 (28 to 54), symptoms duration 12 (5 to 33) years. Only seven patients reported clinically relevant improvement on PGIC; 32 (67%) reported little better, worse or no change (Figure 1). There were small improvements in pain (p=0.048), fatigue (p=0.014) and self-efficacy for physical activity (p=0.012), but the changes were probably not clinically relevant. The improvement seen in patients’ tendency to be mindful at 12 months was sustained (p=0.012). Only 58% were in paid work compared to 70% at baseline. Figure 1. Conclusion Two years after participation in a multicomponent rehabilitation programme comprising mindfulness and acceptance training and physical activity counselling, FM patients still reported high symptom burden and no improvement in their health status. The increased tendency to be mindful was not reflected in improvements in disease-related outcomes. It was not possible to compare groups (intervention and TAU), because the TAU-group had been offered the intervention before the two-years data collection. However, there was no worsening of symptoms, which might have been the case without any intervention. References [1]Macfarlane GJ et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis 2017; 76 :318-28 [2]Haugmark T, et al. Mindfulness and acceptance-based interventions for patients with fibromyalgia: A systematic review and meta-analyses. PLoS One. 2019;14:e0221897 [3]Haugli L et al. Learning to have less pain - is it possible? A one-year follow-up study of the effects of a personal construct group learning programme on patients with chronic musculoskeletal pain. Patient Educ Couns 2001;45:111-18 [4]Haugmark T, et al. Effects of a mindfulness- and acceptance-based group-programme followed by physical activity for patients with fibromyalgia: a randomised controlled trial. BMJ Open June 2021 e046943 Acknowledgements Patient research partners Elisebeth Bærheim and Astrid Andreassen Disclosure of Interests None declared